Judicial Council of California Form SC-104, Proof of Service (Small Claims) Instructions

Enter the name or title of the case.

Enter the court-assigned case number.

Enter the court case number for this matter.

Enter the case name as it appears on the court’s records.

Enter the scheduled hearing date for the case.

Enter the scheduled hearing time for the case.

Enter the court department number or designation for the hearing.

Enter the name of the court and its street address where this case is filed.

Enter the date you are declaring under penalty of perjury that the information provided is true and correct.

Type or print the server's full name.

Check this box if you served the person a copy of form SC-100 (Plaintiff’s Claim and ORDER to Go to Small Claims Court).

Check this box if you served the person a copy of form SC-120 (Defendant’s Claim and ORDER to Go to Small Claims Court).

Check this box if you served an Order for examination (the specific order served is identified in the choices listed below on the form).

Enter the date you mailed the envelope containing the document copies.

Enter the city and state you mailed the envelope from.

Check this box if you mailed the envelope by leaving it at a U.S. Postal Service mail drop.

Check this box if you mailed the envelope by leaving it at an office or business mail drop where you know the mail is picked up every day and deposited with the U.S. Postal Service.

Check this box if someone else mailed the documents for you and you have attached that person’s completed Form SC-104A.

Check this box if the Order for Examination form you served was SC-134. Fill only if 'Order for examination' is 'Yes'.

Check this box if the Order for Examination form you served was AT-138/EJ-125. Fill only if 'Order for examination' is 'Yes'.

Check this box if you served a document other than the ones listed above and will specify the document name on the line provided.

Enter the name(s) of any other document(s) served that are not listed above. Fill only if 'Other (specify)' is 'Yes'.

Enter the full name of the person being served.

Enter the name of the business, agency, or other entity being served.

Enter the name of the person authorized to accept service for the business or entity and that person’s job title.

Check this box if you personally gave copies of the checked documents to the person being served.

Enter the date on which you personally served the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the time at which you personally served the documents. Fill only if 'Personal Service' is 'Yes'.

Check this box if the service time you enter occurred in the morning (a.m.). Fill only if 'Personal Service' is 'Yes'.

Check this box if the service time you enter occurred in the afternoon or evening (p.m.). Fill only if 'Personal Service' is 'Yes'.

Enter the street address where you personally served the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the city where you personally served the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the state where you personally served the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the ZIP code for the location where you personally served the documents. Fill only if 'Personal Service' is 'Yes'.

Enter the full name of the person who served the court papers.

Enter the phone number for the person who served the court papers.

Enter the street address (including apartment or unit number, if any) for the server.

Enter the city where the server’s address is located.

Enter the state where the server’s address is located.

Enter the ZIP code for the server’s address.

Enter the amount charged for serving the court papers.

If the server is a registered process server, enter the county where the server is registered.

If the server is a registered process server, enter the server’s registration number.

Provide a narrative description of how service was completed, including any additional details not captured in the fields above.

Check this box if you served the documents by substituted service (gave them to another adult instead of the person named in item 1).

Check this box if you gave the documents to a competent adult (at least 18) at the person’s home who lives with the person named in item 1. Fill only if 'Substituted Service' is 'Yes'.

Check this box if you gave the documents to an adult who seemed to be in charge where the person named in item 1 usually works. Fill only if 'Substituted Service' is 'Yes'.

Check this box if you gave the documents to an adult who seemed to be in charge where the person named in item 1 usually receives mail (or has a private post office box), when there is no known physical address for that person. Fill only if 'Substituted Service' is 'Yes'.

Enter the date you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Enter the time you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Check this box if the substituted service time you entered was in the morning (a.m.). Fill only if 'Substituted Service' is 'Yes'.

Check this box if the substituted service time you entered was in the afternoon or evening (p.m.). Fill only if 'Substituted Service' is 'Yes'.

Enter the street address where you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Enter the city where you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Enter the state where you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.

Enter the ZIP code for the address where you delivered the court papers by substituted service. Fill only if 'Substituted Service' is 'Yes'.